Crenolanib for Treating FLT3 Mutated Proliferative Disorders

ABSTRACT

The present invention relates to the use of crenolanib, in a pharmaceutically acceptable salt form for the treatment of FLT3 mutated proliferative disorders driven by constitutively activated mutant FLT3, and to a method of treatment of warm-blooded animals, preferably humans, in which a therapeutically effective dose of crenolanib is administered to an animal suffering from said disease or condition:

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a continuation of U.S. patent application Ser. No.15/715,274, filed Sep. 26, 2017, now U.S. Pat. No. 10,213,423, issuedFeb. 26, 2019, which is a continuation of U.S. patent application Ser.No. 15/195,297, filed Jun. 28, 2016, now U.S. Pat. No. 9,801,870 issuedOct. 31, 2017, which is a continuation of U.S. patent application Ser.No. 14/703,500, filed May 4, 2015, now U.S. Pat. No. 9,393,240 issuedJun. 19, 2016, which is a continuation of U.S. patent application Ser.No. 14/053,011, filed Oct. 14, 2013, now U.S. Pat. No. 9,101,624 issuedAug. 11, 2015, which claims priority to U.S. Provisional ApplicationSer. No. 61/749,695, filed Jan. 7, 2013, the entire contents of whichare incorporated herein by reference.

TECHNICAL FIELD OF THE INVENTION

The present invention relates to the use of crenolanib, in apharmaceutically acceptable salt form for the treatment of FLT3 mutatedproliferative disorder(s) driven by constitutively activated mutantFLT3, and to a method of treatment of warm-blooded animals, preferablyhumans, in which a therapeutically effective dose of crenolanib isadministered to a subject suffering from said disease or condition.

STATEMENT OF FEDERALLY FUNDED RESEARCH

Not applicable.

INCORPORATION-BY-REFERENCE OF MATERIALS FILED ON COMPACT DISC

Not applicable.

BACKGROUND OF THE INVENTION

Without limiting the scope of the invention, its background is describedin connection with FLT3 tyrosine kinase.

The FMS-like tyrosine kinase 3 (FLT3) gene encodes a membrane boundreceptor tyrosine kinase that affects hematopoiesis leading tohematological disorders and malignancies. See Drexler, H G et al.Expression of FLT3 receptor and response to FLT3 ligand by leukemiccells. Leukemia. 1996; 10:588-599; Gilliland, D G and J D Griffin. Theroles of FLT3 in hematopoiesis and leukemia. Blood. 2002; 100:1532-1542;Stirewalt, D L and J P Radich. The role of FLT3 in hematopoieticmalignancies. Nat Rev Cancer. 2003; 3:650-665. Activation of FLT3receptor tyrosine kinases is initiated through the binding of the FLT3ligand (FLT3-L) to the FLT3 receptor, also known as Stem cell tyrosinekinase-1 (STK-1) and fetal liver kinase-2 (flk-2), which is expressed onhematopoietic progenitor and stem cells.

FLT3 is one of the most frequently mutated genes in hematologicalmalignancies, present in approximately 30% of adult acute myeloidleukemias (AML). See Nakao M, S Yokota and T Iwai. Internal tandemduplication of the FLT3 gene found in acute myeloid leukemia. Leukemia.1996; 10:1911-1918; H Kiyoi, M Towatari and S Yokota. Internal Tandemduplication of the FLT3 gene is a novel modality of elongation mutation,which causes constitutive activation of the product. Leukemia. 1998;12:1333-1337; P D Kottaridis, R E Gale, et al. The presence of a FLT3internal tandem duplication in patients with acute myeloid leukemia(AML) adds important prognostic information to cytogenetic risk groupand response to the first cycle of chemotherapy: analysis of 854patients from the United Kingdom Medical Research Council AML 10 and 12trials. Blood. 2001; 98:1742-1759; Yamamoto Y, Kiyoi H, Nakano Y.Activating mutation of D835 within the activation loop of FLT3 in humanhematologic malignancies. Blood. 2001; 97:2434-2439; Thiede C, CSteudel, Mohr B. Analysis of FLT3-activating mutations in 979 patientswith acute myelogenous leukemia: association with FAB subtypes andidentification of subgroups with poor prognosis. Blood. 2002;99:4326-4335.

The most common FLT3 mutations are internal tandem duplications (ITDs)that lead to in-frame insertions within the juxtamembrane domain of theFLT3 receptor. FLT3-ITD mutations have been reported in 15-35% of adultAML patients. See Nakao M, S Yokota and T Iwai. Internal tandemduplication of the FLT3 gene found in acute myeloid leukemia. Leukemia.1996; 10:1911-1918; H Kiyoi, M Towatari and S Yokota. Internal Tandemduplication of the FLT3 gene is a novel modality of elongation mutation,which causes constitutive activation of the product. Leukemia. 1998;12:1333-1337; H Kiyoi, T Naoe and S Yokota. Internal tandem duplicationof FLT3 associated with leukocytosis in acute promyelocytic leukemia.Leukemia Study Group of the Ministry of Health and Welfare (Kohseisho).Leukemia. 1997; 11:1447-1452; S Schnittger, C Schoch and M Duga.Analysis of FLT3 length mutations in 1003 patients with acute myeloidleukemia: correlation to cytogenetics, FAB subtype, and prognosis in theAMLCG study and usefulness as a marker for the detection of minimalresidual disease. Blood. 2002; 100:59-66. A FLT3-ITD mutation is anindependent predictor of poor patient prognosis and is associated withincreased relapse risk after standard chemotherapy, and decreaseddisease free and overall survival. See FM Abu-Duhier, Goodeve A C,Wilson G A, et al. FLT3 internal tandem duplication mutations in adultacute myeloid leukemia define a high risk group. British Journal ofHaematology. 2000; 111:190-195; H Kiyoi, T Naoe, Y Nakano, et al.Prognostic implication of FLT3 and N-RAS gene mutations in acute myeloidleukemia. Blood. 1999; 93:3074-3080.

Less frequent are FLT3 point mutations that arise in the activation loopof the FLT3 receptor. The most commonly affected codon is aspartate 835(D835). Nucleotide substitutions of the D835 residue occur inapproximately 5-10% of adult AML patients. See DL Stirewalt and JPRadich. The role of FLT3 in haematopoietic malignancies. Nature ReviewsCancer. 2003; 3:650-665; Y Yamamoto, H Kiyoi and Y Nakano, et al.Activating mutation of D835 within the activation loop of FLT3 in humanhematologic malignancies. Blood. 2001; 97:2434-2439; C Thiede, SteudalC, Mohr B, et al. A nalysis of FLT3-activating mutations in 979 patientswith acute myelogenous leukemia: association with FAB subtypes andidentification of subgroups with poor prognosis. Blood. 2002;99:4326-4335; U Bacher, Haferlach C, W Kern, et al. Prognostic relevanceof FLT3-TKD mutations in AML: the combination matters—an analysis of3082 patients. Blood. 2008; 111:2527-2537.

The heightened frequency of constitutively activated mutant FLT3 inadult AML has made the FLT3 gene a highly attractive drug target in thistumor type. Several FLT3 inhibitors with varying degrees of potency andselectivity for the target have been or are currently being investigatedand examined in AML patients. See T Kindler, Lipka D B, and Fischer T.FLT3 as a therapeutic target in AML: still challenging after all theseyears. Blood. 2010; 116:5089-102.

FLT3 inhibitors known in the art include Lestaurtinib (also known as CEP701, formerly KT-555, Kyowa Hakko, licensed to Cephalon); CHIR-258(Chiron Corp.); EB10 and IMC-EB10 (ImClone Systems Inc.); Midostaurin(also known as PKC412, Novartis AG); Tandutinib (also known as MLN-518,formerly CT53518, COR Therapeutics Inc., licensed to MillenniumPharmaceuticals Inc.); Sunitinib (also known as SU11248, Pfizer USA);Quizartinib (also known as AC220, Ambit Biosciences); XL 999 (ExelixisUSA, licensed to Symphony Evolution, Inc.); GTP 14564 (Merck BiosciencesUK); AG1295 and AG1296; CEP-5214 and CEP-7055 (Cephalon). The followingPCT International Application and U.S. patent application publicationsdisclose additional kinase modulators, including modulators of FLT3: WO2002032861, WO 2002092599, WO 2003035009, WO 2003024931, WO 2003037347,WO 2003057690, WO 2003099771, WO 2004005281, WO 2004016597, WO2004018419, WO 2004039782, WO 2004043389, WO 2004046120, WO 2004058749,WO 2004058749, WO 2003024969 and U.S. Patent Application No.20040049032. See also Levis M, KF Tse, et al. 2001 “A FLT3 tyrosinekinase inhibitor is selectively cytotoxic to acute myeloid leukemiablasts harboring FLT3 internal tandem duplication mutations.” Blood98(3): 885-887; Tse K F, et al., Inhibition of FLT3-mediatedtransformation by use of a tyrosine kinase inhibitor. Leukemia. July2001; 15 (7): 1001-1010; Smith, B. Douglas et al., Single agent CEP-701,a novel FLT3 inhibitor, shows biologic and clinical activity in patientswith relapsed or refractory acute myeloid leukemia Blood, May 2004; 103:3669-3676; Griswold, Ian J. et al., Effects of MLN518, A Dual FLT3 andKIT Inhibitor, on Normal and Malignant Hematopoiesis. Blood, November2004; 104 (9): 2912-2918 [Epub ahead of print July 8]; Yee, Kevin W. H.et al., SU5416 and SU5614 inhibit kinase activity of wild-type andmutant FLT3 receptor tyrosine kinase. Blood, October 2002; 100(8):2941-2949. O'Farrell, Anne-Marie et al., SU11248 is a novel FLT3tyrosine kinase inhibitor with potent activity in vitro and in vivo.Blood, May 2003; 101(9): 3597-3605; Stone, R. M et al., PKC-412 FLT3inhibitor therapy in AML: results of a phase II trials. Ann. Hematol.2004; 83 Suppl 1:S89-90; and Murata, K. et al., Selective cytotoxicmechanism of GTP-14564, a novel tyrosine kinase inhibitor in leukemiacells expressing a constitutively active Fms-like tyrosine kinase 3(FLT3). J Biol Chem. Aug. 29, 2003; 278 (35): 32892-32898 [Epub 2003Jun. 18]; Levis, Mark et al., Small Molecule FLT3 Tyrosine KinaseInhibitors. Current Pharmaceutical Design, 2004, 10, 1183-1193.

The aforementioned inhibitors have either been or are currently beinginvestigated in the preclinical setting, or phase I and II trials asmonotherapy in relapsed AML, or in phase III combination studies inrelapsed AML. Despite reports of successful inhibition of FLT3 withthese compounds in preclinical studies, complete remissions have rarelybeen achieved in FLT3 mutant AML patients in the clinical setting. Inthe majority of patients, the clinical response is short-lived. Responsecriteria for AML clinical trials are adapted from the InternationalWorking Group for AML. See Cheson et al. Revised Recommendations of theInternational Working Group for Diagnosis, Standardization of ResponseCriteria, Treatment Outcomes, and Reporting Standards for TherapeuticTrials in Acute Myeloid Leukemia. J Clin Oncol. 2003; 21: 4642-4649.Responders are patients who obtain a Complete Response (CR), CompleteResponse with incomplete blood count recovery (CRi), or PartialRemission (PR). Briefly, criteria are as follows:

1. Complete Remission (CR):

-   -   a. Peripheral blood counts:        -   i. No circulating blasts        -   ii. Neutrophil count ≥1.0×10⁹/L        -   iii. Platelet count ≥100×10⁹/L    -   b. Bone marrow aspirate and biopsy:        -   i. ≤5% blasts        -   ii. No Auer Rods        -   iii. No extramedullary leukemia

2. Complete remission with incomplete blood count recovery (CRi):

-   -   a. Peripheral blood counts:        -   i. No circulating blasts        -   ii. Neutrophil count ≤1.0×10⁹/L, or        -   iii. Platelet count ≤100×10⁹/L    -   b. Bone marrow aspirate and biopsy        -   i. ≤5% blasts        -   ii. No Auer Rods        -   iii. No extramedullary leukemia

3. Partial remission:

-   -   a. All CR criteria if abnormal before treatment except:    -   b. ≥50% reduction in bone marrow blast but still >5%

To date, clinical responses to FLT3 inhibitors have been primarilylimited to clearance of peripheral blood (PB) blasts, which frequentlyreturn within a matter of weeks, while bone marrow (BM) blasts remainlargely unaffected. For example, treatment with sorafenib, the priormentioned multi-kinase inhibitor with activity against mutant FLT3,while effective in clearing PB blasts, has resulted in only modest BMblast reductions. See G Borthakur et al. Phase I study of sorafenib inpatients with refractory or relapsed acute leukemias. Haematologica.January 2011; 96: 62-8. BM blast percentage plays a central role in thediagnosis and classification of AML. The presence of a heightenedpercentage of blasts in BM is associated with significantly shorteroverall survival. See Small D. FLT3 mutations: biology and treatment.Hematology Am Soc Hematol Educ Program. 2006: 178-84; HM Amin et al.Having a higher blast percentage in circulation than bone marrow:clinical implications in myelodysplastic syndrome and acute lymphoid andmyeloid leukemias. Leukemia. 2005; 19: 1567-72. To effectively treatFLT3 mutated AML patients and overcome the significant unmet need inthis patient population, an inhibitor that significantly depletes bothPB and BM blasts, bridge high risk and heavily pretreated patients tostem cell transplant, and can help to decrease relapse rates andincrease overall survival in early stage disease patients. The currentinvention seeks to overcome disadvantages of the prior art.

SUMMARY OF THE INVENTION

In one embodiment, the present invention includes a method for treatinga FLT3 mutated proliferative disorder in a patient which comprisesadministering to the patient a therapeutically effective amount ofcrenolanib or a pharmaceutically acceptable salt thereof. In one aspect,the method may also include identifying a patient with a proliferativedisorder selected from at least one of a leukemia, myeloma,myeloproliferative disease, myelodysplastic syndrome, idiopathichypereosinophilic syndrome (HES), bladder cancer, breast cancer,cervical cancer, CNS cancer, colon cancer, esophageal cancer, head andneck cancer, liver cancer, lung cancer, nasopharyngeal cancer,neuroendocrine cancer, ovarian cancer, pancreatic cancer, prostatecancer, renal cancer, salivary gland cancer, small cell lung cancer,skin cancer, stomach cancer, testicular cancer, thyroid cancer, uterinecancer, and hematologic malignancy. In another aspect, thetherapeutically effective amounts of crenolanib or a pharmaceuticallyacceptable salt thereof are from about 50 to 500 mg per day, 100 to 450mg per day, 200 to 400 mg per day, 300 to 500 mg per day, 350 to 500 mgper day, or 400 to 500 mg per day. In another aspect, the crenolanib ora pharmaceutically acceptable salt thereof is administered at least oneof continuously, intermittently, systemically, or locally. In anotheraspect, the mutated FLT3 is defined further as a constitutively activeFLT3 mutant. In another aspect, the crenolanib or a pharmaceuticallyacceptable salt thereof is administered orally, intravenously, orintraperitoneally. In another aspect, the crenolanib or apharmaceutically acceptable salt thereof is crenolanib besylate,crenolanib phosphate, crenolanib lactate, crenolanib hydrochloride,crenolanib citrate, crenolanib acetate, crenolanib toluenesulphonate andcrenolanib succinate. In another aspect, the FLT3 is at least one ofFLT3-ITD or FLT3-TKD. In another aspect, the therapeutically effectiveamount of crenolanib or a pharmaceutically acceptable salt thereof isadministered up to three times or more a day for as long as the subjectis in need of treatment for the proliferative disorder. In anotheraspect, the crenolanib or a pharmaceutically acceptable salt thereof isprovided at least one of sequentially or concomitantly, with anotherpharmaceutical agent in a newly diagnosed proliferative disorderpatient, to maintain remission of an existing patient, or arelapsed/refractory proliferative disease patient. In another aspect,the crenolanib or a pharmaceutically acceptable salt thereof is providedas a single agent or in combination with another pharmaceutical agent ina patient with a newly diagnosed proliferative disorder, to maintainremission, or a relapsed/refractory proliferative disease patient. Inanother aspect, the crenolanib or a pharmaceutically acceptable saltthereof is provided as a single agent or in combination with anotherpharmaceutical agent in a newly diagnosed proliferative disorderpediatric patient, to maintain remission, or a relapsed/refractoryproliferative disorder pediatric patient. In another aspect, the patientis relapsed/refractory to other FLT3 tyrosine kinase inhibitors.

Another embodiment of the present invention includes a method fortreating a patient suffering from a proliferative disease comprising:identifying the patient in need of therapy for the proliferativedisease; and administering to the patient in need of such treatment atherapeutically effective amount of Crenolanib or a salt thereof,wherein the cell proliferative disorder is characterized by deregulatedFLT3 receptor tyrosine kinase activity, wherein the proliferativedisease is selected from at least one of a leukemia, myeloma,myeloproliferative disease, myelodysplastic syndrome, idiopathichypereosinophilic syndrome (HES), bladder cancer, breast cancer,cervical cancer, CNS cancer, colon cancer, esophageal cancer, head andneck cancer, liver cancer, lung cancer, nasopharyngeal cancer,neuroendocrine cancer, ovarian cancer, pancreatic cancer, prostatecancer, renal cancer, salivary gland cancer, small cell lung cancer,skin cancer, stomach cancer, testicular cancer, thyroid cancer, uterinecancer, and hematologic malignancy. In one aspect, the crenolanib or apharmaceutically acceptable salt thereof is administered orally,intravenously, or intraperitoneally. In another aspect, the crenolanibor a pharmaceutically acceptable salt thereof is at least one ofCrenolanib Besylate, Crenolanib Phosphate, Crenolanib Lactate,Crenolanib Hydrochloride, Crenolanib Citrate, Crenolanib Acetate,Crenolanib Touluenesulphonate and Crenolanib Succinate CrenolanibBesylate. In another aspect, the FLT3 is at least one of FLT3-ITD orFLT3-TKD. In another aspect, the crenolanib or a pharmaceuticallyacceptable salt thereof is provided at least one of sequentially orconcomitantly, with another chemotherapeutic agent in a newly diagnosedproliferative disease, to maintain remission, or a relapsed/refractoryproliferative disease. In another aspect, the crenolanib or apharmaceutically acceptable salt thereof is provided as a single agentor in combination with another chemotherapeutic agent for treatment ofpediatric patient with the proliferative disease. In another aspect, thecrenolanib or a pharmaceutically acceptable salt thereof is provided asa single agent to at least one of post standard induction therapy, orhigh dose induction therapy, in newly diagnosed proliferative disease.In another aspect, the crenolanib or a pharmaceutically acceptable saltthereof is provided as a single agent in treatment of patients with theproliferative disease that is either refractory to, or has relapsedafter prior treatment with a chemotherapeutic agent. In another aspect,the patient is refractory to at least one other tyrosine kinaseinhibitor.

Yet another embodiment of the present invention includes a method fortreating a patient suffering from leukemia comprising: obtaining asample from the patient suspected of having a leukemia; determining fromthe patient sample that the patient has a deregulated FLT3 receptortyrosine kinase; and administering to the patient in need of suchtreatment a therapeutically effective amount of Crenolanib or a saltthereof, wherein the leukemia is characterized by deregulated FLT3receptor tyrosine kinase activity. In one aspect, the leukemia isselected from Hodgkin's disease, and myeloma, acute lymphocytic leukemia(ALL), acute myeloid leukemia (AML), acute promyelocytic leukemia (APL),chronic lymphocytic leukemia (CLL), chronic myeloid leukemia (CML),chronic neutrophilic leukemia (CNL), acute undifferentiated leukemia(AUL), anaplastic large-cell lymphoma (ALCL), prolymphocytic leukemia(PML), juvenile myelomonocytic leukemia (JMML), adult T-cell ALL, AML,with trilineage myelodysplasia (AMLITMDS), mixed lineage leukemia (MLL),myelodysplastic syndromes (MDSs), myeloproliferative disorders (MPD),and multiple myeloma (MM).

Yet another embodiment of the present invention includes a method forspecifically inhibiting a deregulated receptor tyrosine kinasecomprising: obtaining a patient sample and determining which receptortyrosine kinases are deregulated; and administering to a mammal in needof such treatment a therapeutically effective amount of crenolanib or asalt thereof, wherein the deregulated receptor tyrosine kinase is a FLT3receptor tyrosine kinase. In one aspect, the therapeutically effectiveamount of crenolanib or a salt thereof is provided in an amount thatdecreases patient circulating peripheral blood blast count. In anotheraspect, the therapeutically effective amount of crenolanib or a saltthereof is provided in an amount that decreases a patient bone marrowblast count. In another aspect, the proliferative disease is selectedfrom at least one of a leukemia, myeloma, myeloproliferative disease,myelodysplastic syndrome, idiopathic hypereosinophilic syndrome (HES),bladder cancer, breast cancer, cervical cancer, CNS cancer, coloncancer, esophageal cancer, head and neck cancer, liver cancer, lungcancer, nasopharyngeal cancer, neuroendocrine cancer, ovarian cancer,pancreatic cancer, prostate cancer, renal cancer, salivary gland cancer,small cell lung cancer, skin cancer, stomach cancer, testicular cancer,thyroid cancer, uterine cancer, and hematologic malignancy. In anotheraspect, the therapeutically effective amount can also be aprophylactically effective amount of crenolanib or a salt thereof andare from about 50 to 500 mg per day, 100 to 450 mg per day, 200 to 400mg per day, 300 to 500 mg per day, 350 to 500 mg per day, or 400 to 500mg per day. In another aspect, the crenolanib or a salt thereof isadministered at least one of continuously, intermittently, systemically,or locally. In another aspect, the deregulated FLT3 is defined furtheras a mutated FLT3 is constitutively active. In another aspect, thecrenolanib or a salt thereof is administered orally, intravenously, orintraperitoneally. In another aspect, the crenolanib or a salt thereofis at least one of Crenolanib Besylate, Crenolanib Phosphate, CrenolanibLactate, Crenolanib Hydrochloride, Crenolanib Citrate, CrenolanibAcetate, Crenolanib Touluenesulphonate and Crenolanib SuccinateCrenolanib Besylate. In another aspect, the FLT3 is at least one ofFLT3-ITD or FLT3-TKD. In another aspect, the therapeutically effectiveamount of the crenolanib or a salt thereof is administered up to threetimes or more a day for as long as the subject is in need of treatmentfor the proliferative disease. In another aspect, the patient isprovided treatment, and the method further comprises the steps of:obtaining one or more patient samples to determine the effect of thetreatment, and continuing treatment until the proliferative disease isreduced or eliminated. In another aspect, the crenolanib or a saltthereof is provided at least one of sequentially or concomitantly, withanother pharmaceutical agent in a newly diagnosed proliferative diseasepatient, to maintain remission, or a relapsed/refractory proliferativedisease patient. In another aspect, the crenolanib or a salt thereof isprovided as a single agent or in combination with another pharmaceuticalagent in a newly diagnosed proliferative disease patient, to maintainremission, or a relapsed/refractory proliferative disease patient. Inanother aspect, the crenolanib or a salt thereof is provided as a singleagent or in combination with another pharmaceutical agent in a newlydiagnosed proliferative disease pediatric patient, to maintainremission, or a relapsed/refractory proliferative disease pediatricpatient. In another aspect, the patient is relapsed/refractory to aprior tyrosine kinase inhibitor. Non-limiting examples of other FLT3inhibitors to which the proliferative disease or disorder is resistantincludes, e.g., Lestaurtinib (also known as CEP 701, Cephalon); CHIR-258(Chiron Corp.); EB10 and IMC-EB10 (ImClone Systems Inc.); Midostaurin(also known as PKC412, Novartis AG); Tandutinib (also known as MLN-518,Millennium Pharmaceuticals Inc.); Sunitinib (also known as SU11248,Pfizer USA); Quizartinib (also known as AC220, Ambit Biosciences); XL999 (Symphony Evolution, Inc.); GTP 14564 (Merck Biosciences UK); AG1295and AG1296; and CEP-5214 and CEP-7055 (Cephalon).

Yet another embodiment of the present invention includes a method fortreating a patient with a proliferative disease comprising: obtaining asample from the patient; determining if the patient that has becomeresistant to prior tyrosine kinase inhibitors; and administering atherapeutically effective amount of Crenolanib or a salt thereof toovercome the resistance to the prior protein tyrosine kinase inhibitors.This summary of the invention does not necessarily describe allnecessary features of the invention.

DETAILED DESCRIPTION OF THE INVENTION

While the making and using of various embodiments of the presentinvention are discussed in detail below, it should be appreciated thatthe present invention provides many applicable inventive concepts thatcan be embodied in a wide variety of specific contexts. The specificembodiments discussed herein are merely illustrative of specific ways tomake and use the invention and do not delimit the scope of theinvention.

To facilitate the understanding of this invention, a number of terms aredefined below. Terms defined herein have meanings as commonly understoodby a person of ordinary skill in the areas relevant to the presentinvention. Terms such as “a”, “an” and “the” are not intended to referto only a singular entity, but include the general class of which aspecific example may be used for illustration. The terminology herein isused to describe specific embodiments of the invention, but their usagedoes not delimit the invention, except as outlined in the claims.

The present invention comprises the use of the compounds of the presentinvention to treat disorders related to FLT3 kinase activity orexpression in a subject, e.g., deregulated FLT3 tyrosine kinaseactivity.

The compound is Crenolanib (4-Piperidinamine,1-[2-[5-[(3-methyl-3-oxetanyl)methoxy]-1H-benzimidazol-1-yl]-8-quinolinyl]) and its pharmaceuticallyacceptable salts, which are protein tyrosine kinase inhibitors selectivefor constitutively active FLT3 mutations, including FLT3 ITD and FLT3TKD mutations. Unlike prior FLT3 inhibitors in the art, the besylatesalt form of crenolanib has shown to be remarkably effective indepleting absolute circulating peripheral blood blasts and bone marrowblast percentages in heavily pretreated FLT3 mutant AML patients.

In one embodiment to this aspect, the present invention provides amethod for reducing or inhibiting the kinase activity of FLT3 in asubject comprising the step of administering a compound of the presentinvention to the subject.

As used herein, the term “subject” refers to an animal, such as a mammalor a human, who has been the object of treatment, observation orexperiment.

In other embodiments, the present invention provides therapeutic methodsfor treating a subject with a cell proliferative disorder driven byaberrant kinase activity of mutant FLT3.

In one example, the invention provides methods for treating a cellproliferative disorder related to mutant FLT3, comprising administrationof a therapeutically effective amount of a pharmaceutical compositioncomprising a compound of the present invention in a subject.Administration of the therapeutic agent can occur upon manifestation ofsymptoms characteristic of the FLT3 driven cell proliferative disorder,such that a disease or disorder treated.

As used herein, the term “therapeutically effective amount”, refers toan amount of active compound or pharmaceutical salt that elicits thebiological or medicinal response in a subject that is being sought by aresearcher, veterinarian, medical doctor or other clinician, whichincludes alleviation of the symptoms of the disease or disorder beingtreated. Methods for determining therapeutically effective doses forpharmaceutical compositions comprising a compound of the presentinvention are known in the art. Techniques and compositions for makinguseful dosage forms using the present invention are described in one ormore of the following references: Anderson, Philip 0.; Knoben, James E.;Troutman, William G, eds., Handbook of Clinical Drug Data, TenthEdition, McGraw-Hill, 2002; Pratt and Taylor, eds., Principles of DrugAction, Third Edition, Churchill Livingston, N.Y., 1990; Katzung, ed.,Basic and Clinical Pharmacology, Ninth Edition, McGraw Hill, 20037ybg;Goodman and Gilman, eds., The Pharmacological Basis of Therapeutics,Tenth Edition, McGraw Hill, 2001; Remington's Pharmaceutical Sciences,20th Ed., Lippincott Williams & Wilkins., 2000; Martindale, The ExtraPharmacopoeia, Thirty-Second Edition (The Pharmaceutical Press, London,1999); relevant portions incorporated herein by reference.

As used herein, the term “composition” refers to a product comprisingthe specified ingredients in the specified amounts, as well as anyproduct, which results, directly or indirectly, from combinations of thespecified ingredients in the specified amounts. In one example, thecomposition includes crenolanib or a pharmaceutically acceptable saltthereof in an amount sufficient for the treatment of a disease.

As used herein, the terms “FLT3 mutated proliferative disorder(s)”,“disorder related to FLT3,” or “disorders related to FLT3 receptor,” or“disorders related to FLT3 receptor tyrosine kinase,” “a deregulatedFLT3 receptor tyrosine kinase disease” or “FLT3 driven cellproliferative disorder” includes diseases associated with or implicatingFLT3 activity, for example, mutations leading to constitutive activationof FLT3. Examples of “FLT3 mutated proliferative disorder(s)” includedisorders resulting from over stimulation of FLT3 due to mutations inFLT3, or disorders resulting from abnormally high amount of FLT3activity due to abnormally high amount of mutations in FLT3. It is knownthat over-activity of FLT3 has been implicated in the pathogenesis ofmany diseases, including the following listed cell proliferativedisorders, neoplastic disorders and cancers. Non-limiting examples ofproliferative disorders for treatment with the present invention includeleukemia, myeloma, myeloproliferative disease, myelodysplastic syndrome,idiopathic hypereosinophilic syndrome (HES), bladder cancer, breastcancer, cervical cancer, CNS cancer, colon cancer, esophageal cancer,head and neck cancer, liver cancer, lung cancer, nasopharyngeal cancer,neuroendocrine cancer, ovarian cancer, pancreatic cancer, prostatecancer, renal cancer, salivary gland cancer, small cell lung cancer,skin cancer, stomach cancer, testicular cancer, thyroid cancer, uterinecancer, and hematologic malignancy.

As used herein, the terms “proliferative disorder(s)” and “cellproliferative disorder(s)” refer to excess cell proliferation of one ormore subset of cells in a multicellular organism resulting in harm (i.e.discomfort or decreased life expectancy) to the multicellular organism.Cell proliferative disorders can occur in different types of animals andhumans. As used herein, “cell proliferative disorders” includeneoplastic disorders.

As used herein, the term “neoplastic disorder” refers to a tumorresulting from abnormal or uncontrolled cellular growth. Examples ofneoplastic disorders include, but are not limited to the followingdisorders, for instance: the myeloproliferative disorders, such asthrombocytopenia, essential thrombocytosis (ET), agnogenic myeloidmetaplasia, myelofibrosis (MF), myelofibrosis with myeloid metaplasia(MMM), chronic idiopathic myelofibrosis (UIMF), and polycythemia vera(PV), the cytopenias, and pre-malignant myelodysplastic syndromes;cancers such as glioma cancers, lung cancers, breast cancers, colorectalcancers, prostate cancers, gastric cancers, esophageal cancers, coloncancers, pancreatic cancers, ovarian cancers, and hematologicalmalignancies, including myelodysplasia, multiple myeloma, leukemias, andlymphomas. Examples of hematological malignancies include, for instance,leukemias, lymphomas, Hodgkin's disease, and myeloma. Also, acutelymphocytic leukemia (ALL), acute myeloid leukemia (AML), acutepromyelocytic leukemia (APL), chronic lymphocytic leukemia (CLL),chronic myeloid leukemia (CML), chronic neutrophilic leukemia (CNL),acute undifferentiated leukemia (AUL), anaplastic large-cell lymphoma(ALCL), prolymphocytic leukemia (PML), juvenile myelomonocytic leukemia(JMML), adult T-cell ALL, AML, with trilineage myelodysplasia(AMLITMDS), mixed lineage leukemia (MLL), myelodysplastic syndromes(MDSs), myeloproliferative disorders (MPD), and multiple myeloma (MM).In certain embodiments, the present invention is directed at the use ofcrenolanib or a pharmaceutically acceptable salt thereof in an amountsufficient for the treatment of a neoplastic disorder.

In one embodiment of the present invention, the crenolanib or apharmaceutically acceptable salt thereof is provided at least one ofsequentially or concomitantly, with another chemotherapeutic agent in anewly diagnosed proliferative disease, to maintain remission, or arelapsed/refractory proliferative disease. The crenolanib or apharmaceutically acceptable salt thereof may be provided as a singleagent or in combination with another chemotherapeutic agent fortreatment of pediatric patient with the proliferative disease. Thecrenolanib or a pharmaceutically acceptable salt thereof may also beprovided as a single agent to at least one of post standard inductiontherapy, or high dose induction therapy, in newly diagnosedproliferative disease. The crenolanib or a pharmaceutically acceptablesalt thereof may also be provided as a single agent in treatment ofpatients with the proliferative disease that is either refractory to, orhas relapsed after prior treatment with a chemotherapeutic agent.Finally, the patient may be refractory to at least one other tyrosinekinase inhibitor prior to treatment.

In a further embodiment, the present invention can be combined withanother therapy as a combination therapy for treating or inhibiting theonset of a cell proliferative disorder related to FLT3 in a subject. Thecombination therapy comprises the administration of a therapeuticallyeffective amount of a compound of the present invention and one or moreother anti-cell proliferation therapies including, but not limited to,chemotherapy and radiation therapy.

In an embodiment of the present invention, a compound of the presentinvention may be administered in combination with chemotherapy. Usedherein, chemotherapy refers to a therapy involving a chemotherapeuticagent. A variety of chemotherapeutic agents may be used in combinationwith the present invention. By way of example only, taxane compounds,specifically docetaxel, is safely administered in combination with acompound of the present invention in a dosage of 75 mg per square meter(mg/m²) of body surface area.

Chemotherapy is known to those skilled in the art. The appropriatedosage and scheme for chemotherapy will be similar to those alreadyemployed in clinical therapies wherein the chemotherapy is delivered incombination with other therapies or used alone.

In another embodiment of the present invention, compounds of the presentinvention may be administered in combination with radiation therapy.Used herein, “radiation therapy” refers to a therapy that comprises theexposure of a subject in need to radiation. Radiation therapy is knownto those skilled in the art. The appropriate dosage and scheme forradiation therapy will be similar to those already employed in clinicaltherapies wherein the radiation therapy is delivered in combination withother therapies or used alone.

In another embodiment of the present invention, the compounds of thepresent invention may be administered in combination with a targetedtherapy. As used herein, “targeted therapy” refers to a therapytargeting a particular class of proteins involved in tumor developmentor oncogenic signaling. For example, tyrosine kinase inhibitors againstvascular endothelial growth factor have been used in treating cancers.

The present invention also includes methods that include the use of asecond pharmaceutical agent in addition to compounds of the presentinvention, the two may be administered simultaneously or sequentially(in either order).

In one embodiment, the present invention is of the compound havingformula I:

or a pharmaceutically acceptable salt or solvate thereof, in atherapeutically or prophylactically effective amount against aproliferative disease is selected from at least one of a leukemia,myeloma, myeloproliferative disease, myelodysplastic syndrome,idiopathic hypereosinophilic syndrome (HES), bladder cancer, breastcancer, cervical cancer, CNS cancer, colon cancer, esophageal cancer,head and neck cancer, liver cancer, lung cancer, nasopharyngeal cancer,neuroendocrine cancer, ovarian cancer, pancreatic cancer, prostatecancer, renal cancer, salivary gland cancer, small cell lung cancer,skin cancer, stomach cancer, testicular cancer, thyroid cancer, uterinecancer, and hematologic malignancy. Pharmaceutically acceptable saltsincluding hydrochloride, phosphate and lactate are prepared in a mannersimilar to the benzenesulfonate salt and are well known to those ofmoderate skill in the art.

Compounds of the present invention may be administered to a subjectsystemically, for example, orally, intravenously, subcutaneously,intramuscular, intradermal or parenterally. The compounds of the presentinvention can also be administered to a subject locally.

Compounds of the present invention may be formulated for slow-release orfast-release with the objective of maintaining contact of compounds ofthe present invention with targeted tissues for a desired range of time.

Compositions suitable for oral administration include solid forms, suchas pills, tablets, caplets, capsules, granules, and powders, liquidforms, such as solutions, emulsions, and suspensions. Forms useful forparenteral administration include sterile solutions, emulsions andsuspensions.

The daily dosage of the compounds of the present invention may be variedover a wide range from 50 to 500 mg per adult human per day. For oraladministration, the compositions are preferably provided in the form oftablets containing 20 and 100 milligrams. The compounds of the presentinvention may be administered on a regimen up to three times or more perday. Preferably three times per day. Optimal doses to be administeredmay be determined by those skilled in the art, and will vary with thecompound of the present invention used, the mode of administration, thetime of administration, the strength of the preparation, and the detailsof the disease condition. Factors associated with patientcharacteristics, such as age, weight, and diet will call for dosageadjustments.

Preparation of the compounds of the present invention. General syntheticmethods, which may be referred to for preparing the compounds of formulaI are provided in U.S. Pat. No. 5,990,146 (issued Nov. 23, 1999)(Warner-Lambert Co.) and PCT published application numbers WO 99/16755(published Apr. 8, 1999) (Merck & Co.) WO 01/40217 (published Jul. 7,2001) (Pfizer, Inc.), US Patent Application No. US 2005/0124599 (Pfizer,Inc.) and U.S. Pat. No. 7,183,414 (Pfizer, Inc.), relevant portionsincorporated herein by reference.

Pharmaceutically acceptable salts such as hydrochloride, phosphate andlactate are prepared in a manner similar to the benzenesulfonate saltand are well known to those of moderate skill in the art. The followingrepresentative compounds of the present invention are for exemplarypurposes only and are in no way meant to limit the invention, includingCrenolanib as Crenolanib Besylate, Crenolanib Phosphate, CrenolanibLactate, Crenolanib Hydrochloride, Crenolanib Citrate, CrenolanibAcetate, Crenolanib Toluenesulphonate and Crenolanib Succinate.

SUMMARY OF EXAMPLES Example 1. Patient Harbored a De Novo FLT3-ITDMutation and an Acquired FLT3-D835 TKD Mutation

Following progression on another FLT3 inhibitor, the patient achieved ahematologic benefit categorized as a CR on crenolanib besylate therapy,and was bridged to a curative allogeneic stem cell transplant.

Example 2. Patient Harbored a De Novo FLT3-ITD Mutation and an AcquiredFLT3-D835 TKD Mutation

Following progression on another FLT3 inhibitor, the patient achievedhematologic benefit categorized as a CRi on crenolanib besylate therapy,and was bridged to a curative allogeneic stem cell transplant.

Example 3. Patient Harbored Acquired FLT-ITD and FLT3-D835 TKD Mutations

Following progression on cytotoxic chemotherapy and an autologous stemcell transplant, the patient achieved hematological benefit categorizedas CRi on crenolanib besylate therapy, and was bridged to a curativeallogeneic stem cell transplant.

Example 4. Patient Harbored an Acquired FLT3-ITD Mutation

Following progression on cytotoxic chemotherapy, the patient achievedhematological benefit characterized as CRi on crenolanib besylatetherapy, and was bridged to a curative allogeneic stem cell transplant.

Example 1

Effect of Crenolanib Besylate Therapy in a Relapsed/Refractory AMLPatient with a De Novo FLT3-ITD Mutation and Acquired FLT3-D835 TKDMutation: CR and Bridge to Transplant.

A 34 year old, 82.28 kg male diagnosed with AML, in July 2012. Atinitial diagnosis, laboratory testing revealed elevated peripheral bloodand bone marrow blasts. The patient was positive for a de novo FLT3-ITDmutation, categorizing him as a high risk AML patient, which isassociated with poor prognosis, increased cumulative incidence ofrelapse and shortened overall survival.

The patient was initially treated with induction chemotherapy includinga standard dose of cytarabine given as a continuous infusion for 7 daysand 3 days of daunorubicin delivered intravenously. Following 1 cycle ofinduction therapy, the patient's bone marrow showed no evidence of AMLand remission was confirmed. To maintain the clinical remission, twocycles of consolidation therapy with high dose cytarabine werecompleted. Approximately 1 month later, a bone marrow biopsy showed thatthe patient had relapsed. With no other approved standard treatmentoptions available, the patient was enrolled on a phase I clinical trialfor relapsed and refractory AML patients, where he was treated twicedaily with an oral investigational FLT3 tyrosine kinase inhibitor, FLT3tyrosine kinase inhibitor Y. Following approximately 3 months of FLT3tyrosine kinase inhibitor Y treatment, the patient's disease progressedand he was withdrawn from the investigational study.

Further analysis showed that the patient had acquired a FLT3-TKDmutation in addition to the FLT3-ITD mutation that was present uponinitial treatment. Presence of both the FLT3-ITD and FLT3-TKD mutationsplaced the patient in an even higher risk group. Due to the increasedaggressive nature of the patient's disease, he was treated with salvagehigh dose cytarabine chemotherapy and hydroxyurea. Despiteadministration of the salvage cytotoxic regimens, there was nosignificant decrease in the patient's bone marrow blast counts. Thepatient discontinued both therapies.

To overcome resistance to prior therapy, the patient was provided singleagent oral crenolanib besylate on a clinical trial for relapsed orrefractory AML patients with a FLT3-D835 TKD mutation (NCT01522469). Atbaseline, the patient presented with 75% bone marrow blasts. The patientbegan treatment with 100 mg of oral crenolanib three times daily.Despite decreasing the crenolanib dose to 80 mg three times daily, after29 days of therapy a bone marrow biopsy revealed that crenolanibovercame prior FLT3 tyrosine kinase inhibitor resistance and the patientachieved complete remission (CR). The sustained clearance of bone marrowblasts made the patient eligible for stem cell transplant (see Table 1).The patient discontinued crenolanib therapy and underwent allogeneicstem cell transplant.

Table 1 illustrates the ability of crenolanib to clear malignantleukemia in the bone marrow of Example 1, a relapsed/refractory AMLpatient with a de novo FLT3-ITD mutation and acquired FLT3-D835 TKDmutation, after only 29 days of therapy.

Days on Study Drug Bone Marrow Blast (%) 0 75 29 0 57 1

Example 2

Effect of Crenolanib Besylate Therapy in a Relapsed/Refractory AMLPatient with a de novo FLT3 ITD Mutation and Acquired FLT3-D835 TKDMutation: CRi and Bridge to Transplant.

A 45 year old, 49.7 kg female diagnosed with AML in February 2012. Atinitial diagnosis, laboratory testing revealed an elevated bone marrowblast percentage of 65%. The patient was positive for a de novo FLT3-ITDmutation, categorizing her as a high risk AML patient, which isassociated with poor prognosis, increased cumulative incidence ofrelapse and shortened overall survival.

The patient was initially treated with induction chemotherapy includinga standard dose of cytarabine given as a continuous infusion for 5 daysand 3 days of idaurubicin given intravenously. Following 1 cycle ofinduction therapy, the patient achieved a clinical complete remission.Laboratory tests showed a decrease in bone marrow blast percentage to 1%at week 5. To maintain the clinical remission, consolidation therapywith high dose cytarabine at 3 g/m² every 12 hours on days 1, 3, and 5was initiated for one cycle. In preparation for a stem cell transplant,the patient underwent an observational bone marrow biopsy. At week 12the bone marrow biopsy showed that the patient had relapsed, with a bonemarrow blast percentage increase to 57%. In an effort to achieve asecond remission, the patient was treated with salvage chemotherapyconsisting of a combination of mitoxantrone, etoposide and cytarabine.At week 16, a bone marrow biopsy revealed that the patient had achieveda second complete remission with 3% bone marrow blasts.

In preparation for a stem cell transplant, the patient underwent anobservational bone marrow biopsy at week 20. The biopsy resultsindicated that the patient experienced a second relapse, with a bonemarrow blast percentage of 30%. With no other approved standardtreatment options available, the patient was enrolled on a clinicaltrial for relapsed and refractory AML patients, where she was treateddaily with an oral investigational FLT3 tyrosine kinase inhibitor, FLT3tyrosine kinase inhibitor X, at dose level 1. Following one treatmentcycle of FLT3 tyrosine kinase inhibitor X, the patient presented with anelevated bone marrow blast percentage of 38%. Further analysis showedthat the patient had acquired a FLT3-TKD mutation in addition to theFLT3-ITD mutation that was present upon initial treatment. Presence ofboth the FLT3-ITD and FLT3-TKD mutations placed the patient in an evenhigher risk group. Due to the increased aggressive nature of thepatient's disease, the daily dose of FLT3 tyrosine kinase inhibitor Xwas increased by 100% to dose level 2. Despite the increased dose ofFLT3 tyrosine kinase inhibitor X, the patient experienced an increase inbone marrow blasts to 60%. The patient discontinued the FLT3 tyrosinekinase inhibitor X investigational study.

To overcome resistance to prior therapy with FLT3 tyrosine kinaseinhibitor X, the patient was provided single agent oral crenolanibbesylate on a clinical trial for relapsed or refractory AML patientswith a FLT3-D835 mutation (NCT01522469). At baseline, the patientpresented with 91% bone marrow blasts and 4800 units/uL of absolutecirculating peripheral blood blasts. The patient began treatment with 80mg of oral crenolanib three times daily. After only 14 days ofcrenolanib therapy, the patient achieved complete clearance of malignantleukemic blasts in her peripheral blood. Over the course of 65 days oftherapy, a bone marrow biopsy revealed that crenolanib overcame priorFLT3 tyrosine kinase inhibitor resistance and the patient achievedcomplete remission with incomplete blood count recovery (CRi). Adecrease in bone marrow blasts to 4-5% made the patient eligible forstem cell transplant (see Tables 1 and 2). The patient discontinuedcrenolanib therapy and underwent allogeneic stem cell transplant.

Table 1 illustrates the ability of crenolanib to clear malignantleukemia in the peripheral blood of Example 2, a relapsed/refractory AMLpatient with a de novo FLT3-ITD mutation and acquired FLT3-D835 TKDmutation, after only 14 days of therapy;

Absolute Peripheral Blast Count Days on Study Drug (units/uL) 1 4800 32747 4 250 7 49 9 35 14 0 21 0 28 0 37 0 38 0 39 0 40 0 41 0 42 0 43 045 0 46 0 47 0 48 0 49 0 50 0 51 0 52 0 69 0

FLT3 Inhibitor Days on Study Drug Bone Marrow Blast (%) FLT3 Inhibitor X0 30 28 38 42 60 Crenolanib 0 91 21 32 35 2 65 4-5

Table 2 illustrates the ability of crenolanib to clear malignantleukemia in the bone marrow of Example 2, a relapsed/refractory AMLpatient with a de novo FLT3-ITD mutation and acquired FLT3-D835 TKDmulalion, for a sustained period of 65 days following immediate relapseon another investigational FLT3 inhibitor;

Example 3

Effect of Crenolanib Besylate Therapy in a Relapsed/Refractory AMLPatient with Acquired FLT3-ITD and FLT3-D835 TKD Mutations: CRi andBridge to Transplant.

A 44 year old, 59.2 kg female diagnosed with AML December 2011.Following initial diagnosis the patient was treated with 7+3 inductionchemotherapy, followed by consolidation therapy with 1 cycle of highdose cytarabine. Five months later the patient underwent autologous stemcell transplantation with etoposide and busulfan conditioning. There wasno evidence of clinical response following transplant. Laboratorytesting revealed that the patient's circulating peripheral blood blastwere elevated two months later and her bone marrow blast percentage was42% three months later. Additionally, it was discovered that the patienthad acquired both a FLT3-ITD and FLT3-D835 TKD mutation. Given the invitro FLT3 target specificity of crenolanib for both of theconstitutively active mutations, the patient was initiated on the phaseII crenolanib monotherapy clinical trial (NCT01522469). At baseline (Day0), before administration of crenolanib besylate, the patient hadabsolute circulating peripheral blood blasts of 196 units/uL and 60-70%bone marrow blasts. The patient was treated with 100 mg of crenolanibbesylate three times daily. After only 15 days of crenolanib therapy,the patient achieved complete clearance of malignant leukemic blasts inher peripheral blood. After 33 days of therapy, a bone marrow biopsyrevealed that while on crenolanib therapy the patient achieved acomplete remission with incomplete blood count recovery (CRi). Adecrease in bone marrow blasts to 5% made the patient eligible for stemcell transplant. The patient discontinued crenolanib therapy to undergoallogeneic stem cell transplantation conditioning. The patientdiscontinued crenolanib therapy and underwent allogeneic stem celltransplant.

Table 3 illustrates ihe ability of crenolanib to clear malignantleukemia in the peripheral blood of Example 3, a heavily pretreatedrelapsed/refractory AML patient with acquired FLT3-ITD and FLT3-D835 TKDmutations, after only 15 days of therapy;

Absolute Peripheral Blast Count Days on Study Drug (units/uL) 0 196 1414 15 0 16 0 17 0 18 0 28 0 29 0 31 0 32 0 33 0 39 0 42 0 44 0 45 0 46 047 0 48 0 49 0 50 0 51 0 52 0

Table 4 illustrates the ability of crenolanib to clear malignantleukemia in the bone marrow of Example 3, a heavily pretreatedrelapsed/refractory AML patient with acquired FLT3-ITD and FLT3-D835 TKDmutations, for a sustained period of 33 days.

Days on Study Drug Bone Marrow Blast (%) 0 60-70 27 10 33 5

Example 4

Effect of Crenolanib Besylate Therapy in a Relapsed/Refractory AMLPatient with an Acquired FLT3-ITD Mutation: CRi and Bridge toTransplant.

A 51 year old, 60.6 kg female diagnosed with FLT3-negative AML January2012. Following initial diagnosis the patient was treated with standard7+3 induction chemotherapy to which complete remission was achieved. Thepatient was then treated with 4 cycles of high dose cytarabineconsolidation therapy. Laboratory testing revealed that the patientprogressed on consolidation therapy. An acquired FLT3-ITD mutation wasnoted upon relapse and the patient was enrolled on the phase IIcrenolanib besylate monotherapy clinical trial (NCT01522469). Atbaseline (Day 0), before administration of crenolanib besylate, thepatient had absolute circulating peripheral blood blasts of 198 units/uLand 76% bone marrow blasts. The patient was treated with 100 mg ofcrenolanib besylate three times daily. After only 15 days of crenolanibtherapy, the patient achieved complete clearance of malignant leukemicblasts in her peripheral blood. After 29 days of therapy, a bone marrowbiopsy revealed that while on crenolanib therapy the patient achieved acomplete remission with incomplete blood count recovery (CRi). Asustained level of bone marrow leukemic blasts at 1% qualified thepatient for a stem cell transplant. The patient discontinued crenolanibtherapy and underwent allogeneic stem cell transplant.

Table 3 illustrates the ability of crenolanib to clear malignantleukemia in the peripheral blood of Example 4, a relapsed/refractory AMLpatient with an acquired FLT3-ITD mutation, after only 15 days oftherapy;

Absolute Peripheral Blast Count Days on Study Drug (cells/uL) 0 198 1130 8 19 15 0 22 0 29 0 58 0

Table 4 illustrates Ihe ability of crenolanib to clear malignantleukemia in the bone marrow of Example 4, a relapsed/refractory AMLpatient with an acquired FLT3-ITD mutation, after only 29 days oftherapy.

Days on Study Drug Bone Marrow Blast (%) 0 76 29 1 58 1

It is contemplated that any embodiment discussed in this specificationcan be implemented with respect to any method, kit, reagent, orcomposition of the invention, and vice versa. Furthermore, compositionsof the invention can be used to achieve methods of the invention.

It will be understood that particular embodiments described herein areshown by way of illustration and not as limitations of the invention.The principal features of this invention can be employed in variousembodiments without departing from the scope of the invention. Thoseskilled in the art will recognize, or be able to ascertain using no morethan routine experimentation, numerous equivalents to the specificprocedures described herein. Such equivalents are considered to bewithin the scope of this invention and are covered by the claims.

All publications and patent applications mentioned in the specificationare indicative of the level of skill of those skilled in the art towhich this invention pertains. All publications and patent applicationsare herein incorporated by reference to the same extent as if eachindividual publication or patent application was specifically andindividually indicated to be incorporated by reference.

The use of the word “a” or “an” when used in conjunction with the term“comprising” in the claims and/or the specification may mean “one,” butit is also consistent with the meaning of “one or more,” “at least one,”and “one or more than one.” The use of the term “or” in the claims isused to mean “and/or” unless explicitly indicated to refer toalternatives only or the alternatives are mutually exclusive, althoughthe disclosure supports a definition that refers to only alternativesand “and/or.” Throughout this application, the term “about” is used toindicate that a value includes the inherent variation of error for thedevice, the method being employed to determine the value, or thevariation that exists among the study subjects.

As used in this specification and claim(s), the words “comprising” (andany form of comprising, such as “comprise” and “comprises”), “having”(and any form of having, such as “have” and “has”), “including” (and anyform of including, such as “includes” and “include”) or “containing”(and any form of containing, such as “contains” and “contain”) areinclusive or open-ended and do not exclude additional, unrecitedelements or method steps.

The term “or combinations thereof” as used herein refers to allpermutations and combinations of the listed items preceding the term.For example, “A, B, C, or combinations thereof” is intended to includeat least one of: A, B, C, AB, AC, BC, or ABC, and if order is importantin a particular context, also BA, CA, CB, CBA, BCA, ACB, BAC, or CAB.

Continuing with this example, expressly included are combinations thatcontain repeats of one or more item or term, such as BB, AAA, AB, BBC,AAABCCCC, CBBAAA, CABABB, and so forth. The skilled artisan willunderstand that typically there is no limit on the number of items orterms in any combination, unless otherwise apparent from the context.

As used herein, words of approximation such as, without limitation,“about”, “substantial” or “substantially” refers to a condition thatwhen so modified is understood to not necessarily be absolute or perfectbut would be considered close enough to those of ordinary skill in theart to warrant designating the condition as being present. The extent towhich the description may vary will depend on how great a change can beinstituted and still have one of ordinary skilled in the art recognizethe modified feature as still having the required characteristics andcapabilities of the unmodified feature. In general, but subject to thepreceding discussion, a numerical value herein that is modified by aword of approximation such as “about” may vary from the stated value byat least ±1, 2, 3, 4, 5, 6, 7, 10, 12 or 15%.

All of the compositions and/or methods disclosed and claimed herein canbe made and executed without undue experimentation in light of thepresent disclosure. While the compositions and methods of this inventionhave been described in terms of preferred embodiments, it will beapparent to those of skill in the art that variations may be applied tothe compositions and/or methods and in the steps or in the sequence ofsteps of the method described herein without departing from the concept,spirit and scope of the invention. All such similar substitutes andmodifications apparent to those skilled in the art are deemed to bewithin the spirit, scope and concept of the invention as defined by theappended claims.

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What is claimed is:
 1. A method for treating a FLT3 mutatedproliferative disorder in a patient that comprises administering to thepatient a therapeutically effective amount of crenolanib or apharmaceutically acceptable salt thereof.
 2. The method of claim 1,wherein the FLT3 mutated proliferative disorder is selected from atleast one of a leukemia, myeloma, myeloproliferative disease,myelodysplastic syndrome, idiopathic hypereosinophilic syndrome (HES),bladder cancer, breast cancer, cervical cancer, CNS cancer, coloncancer, esophageal cancer, head and neck cancer, liver cancer, lungcancer, nasopharyngeal cancer, neuroendocrine cancer, ovarian cancer,pancreatic cancer, prostate cancer, renal cancer, salivary gland cancer,small cell lung cancer, skin cancer, stomach cancer, testicular cancer,thyroid cancer, uterine cancer, and hematologic malignancy.
 3. Themethod of claim 1, wherein the therapeutically effective amount ofcrenolanib or a pharmaceutically acceptable salt thereof are from about50 to 500 mg per day, 100 to 450 mg per day, 200 to 400 mg per day, 300to 500 mg per day, 350 to 500 mg per day, or 400 to 500 mg per day. 4.The method of claim 1, wherein the mutated FLT3 is defined further as aconstitutively active FLT3 mutant.
 5. The method of claim 1, wherein thetherapeutically effective amount of crenolanib or a pharmaceuticallyacceptable salt thereof is administered orally, intravenously, orintraperitoneally.
 6. The method according to claim 1, wherein thecrenolanib is crenolanib besylate, crenolanib phosphate, crenolaniblactate, crenolanib hydrochloride, crenolanib citrate, crenolanibacetate, crenolanib toluenesulphonate and crenolanib succinate.
 7. Themethod of claim 1, wherein the FLT3 is at least one of FLT3-ITD orFLT-TKD.
 8. The method of claim 1, wherein the therapeutically effectiveamount of crenolanib or a pharmaceutically acceptable salt thereof is atleast one of: (1) administered at least one of continuously,intermittently, systemically, or locally, (2) administered up to threetimes or more a day for as long as the subject is in need of treatmentfor the FLT3 mutated proliferative disorder; (3) sequentially orconcomitantly, with another pharmaceutical agent in a newly diagnosedproliferative disease patient, to maintain remission, or arelapsed/refractory proliferative disease patient; (4) as a single agentor in combination with another pharmaceutical agent in a newly diagnosedFLT3 mutated proliferative disorder patient, to maintain remission, or arelapsed/refractory proliferative disease patient; or (5) as a singleagent or in combination with another pharmaceutical agent in a newlydiagnosed FLT3 mutated proliferative disorder pediatric patient, tomaintain remission, or a relapsed/refractory FLT3 mutated proliferativedisorder pediatric patient.
 9. The method of claim 1, wherein thepatient is relapsed/refractory to other FLT3 tyrosine kinase inhibitorsor another chemotherapy.
 10. A method for treating a patient sufferingfrom a FLT3 mutated proliferative disorder comprising: identifying thepatient in need of therapy for the FLT3 mutated proliferative disorder;and administering to the patient in need of such treatment atherapeutically effective amount of Crenolanib or a salt thereof,wherein the FLT3 mutated proliferative disorder is characterized byderegulated FLT3 receptor tyrosine kinase activity, wherein the FLT3mutated proliferative disorder is selected from at least one of aleukemia, myeloma, myeloproliferative disease, myelodysplastic syndrome,idiopathic hypereosinophilic syndrome (HES), bladder cancer, breastcancer, cervical cancer, CNS cancer, colon cancer, esophageal cancer,head and neck cancer, liver cancer, lung cancer, nasopharyngeal cancer,neuroendocrine cancer, ovarian cancer, pancreatic cancer, prostatecancer, renal cancer, salivary gland cancer, small cell lung cancer,skin cancer, stomach cancer, testicular cancer, thyroid cancer, uterinecancer, and hematologic malignancy.
 11. The method of claim 10, whereinthe Crenolanib or a salt thereof is administered orally, intravenously,or intraperitoneally.
 12. The method of claim 10, wherein the Crenolanibor a salt thereof is at least one of Crenolanib Besylate, CrenolanibPhosphate, Crenolanib Lactate, Crenolanib Hydrochloride, CrenolanibCitrate, Crenolanib Acetate, Crenolanib Touluenesulphonate andCrenolanib Succinate Crenolanib Besylate.
 13. The method of claim 10,wherein the FLT3 is at least one of FLT3-ITD or FLT3-TKD.
 14. The methodof claim 10, wherein the therapeutically effective amount of crenolanibor a pharmaceutically acceptable salt thereof is at least one of: (1)administered at least one of continuously, intermittently, systemically,or locally, (2) administered up to three times or more a day for as longas the subject is in need of treatment for the FLT3 mutatedproliferative disorder; (3) sequentially or concomitantly, with anotherpharmaceutical agent in a newly diagnosed FLT3 mutated proliferativedisorder patient, to maintain remission, or a relapsed/refractory FLT3mutated proliferative disorder patient; (4) as a single agent or incombination with another pharmaceutical agent in a newly diagnosed FLT3mutated proliferative disorder patient, to maintain remission, or arelapsed/refractory proliferative disease patient; or (5) as a singleagent or in combination with another pharmaceutical agent in a newlydiagnosed FLT3 mutated proliferative disorder pediatric patient, tomaintain remission, or a relapsed/refractory proliferative diseasepediatric patient.
 15. The method of claim 10, wherein the patient isrefractory to at least one other tyrosine kinase inhibitor or anotherchemotherapy.
 16. A method for treating a patient suffering fromleukemia comprising: obtaining a sample from the patient suspected ofhaving leukemia; determining from the patient sample that the patienthas a deregulated FLT3 receptor tyrosine kinase; and administering tothe patient in need of such treatment a therapeutically effective amountof Crenolanib or a salt thereof, wherein the leukemia is characterizedby deregulated FLT3 receptor tyrosine kinase activity.
 17. The method ofclaim 16, wherein the leukemia is selected from Hodgkin's disease, andmyeloma, acute lymphocytic leukemia (ALL), acute myeloid leukemia (AML),acute promyelocytic leukemia (APL), chronic lymphocytic leukemia (CLL),chronic myeloid leukemia (CML), chronic neutrophilic leukemia (CNL),acute undifferentiated leukemia (AUL), anaplastic large-cell lymphoma(ALCL), prolymphocytic leukemia (PML), juvenile myelomonocytic leukemia(JMML), adult T-cell ALL, AML, with trilineage myelodysplasia(AMLITMDS), mixed lineage leukemia (MLL), myelodysplastic syndromes(MDSs), myeloproliferative disorders (MPD), and multiple myeloma (MM).18. A method for specifically inhibiting a deregulated receptor tyrosinekinase comprising: obtaining a patient sample; determining whichreceptor tyrosine kinases are deregulated; and administering to a mammalin need of such treatment a therapeutically effective amount ofcrenolanib or a salt thereof, wherein the deregulated receptor tyrosinekinase is a FLT3 receptor tyrosine kinase sufficient to treat a FLT3mutated proliferative disorder.
 19. The method of claim 18, wherein thetherapeutically effective amount of crenolanib or a salt thereof isprovided in an amount that decreases patient circulating peripheralblood blast count.
 20. The method of claim 18, wherein thetherapeutically effective amount of crenolanib or a salt thereof isprovided in an amount that decreases a patient bone marrow blast count.21. The method of claim 18, wherein the FLT3 mutated proliferativedisorder is selected from at least one of a leukemia, myeloma,myeloproliferative disease, myelodysplastic syndrome, idiopathichypereosinophilic syndrome (HES), bladder cancer, breast cancer,cervical cancer, CNS cancer, colon cancer, esophageal cancer, head andneck cancer, liver cancer, lung cancer, nasopharyngeal cancer,neuroendocrine cancer, ovarian cancer, pancreatic cancer, prostatecancer, renal cancer, salivary gland cancer, small cell lung cancer,skin cancer, stomach cancer, testicular cancer, thyroid cancer, uterinecancer, and hematologic malignancy.
 22. The method of claim 18, whereinthe therapeutically effective amount of crenolanib or a salt thereof isalso provided prophylactically at effective amounts are from about 50 to500 mg per day, 100 to 450 mg per day, 200 to 400 mg per day, 300 to 500mg per day, 350 to 500 mg per day, or 400 to 500 mg per day.
 23. Themethod of claim 18, wherein the deregulated FLT3 is defined further as amutated FLT3 is constitutively active.
 24. The method of claim 18,wherein therapeutically effective amount of crenolanib or a salt thereofis administered orally, intravenously, or intraperitoneally.
 25. Themethod of claim 18, wherein the Crenolanib is at least one of CrenolanibBesylate, Crenolanib Phosphate, Crenolanib Lactate, CrenolanibHydrochloride, Crenolanib Citrate, Crenolanib Acetate, CrenolanibTouluenesulphonate and Crenolanib Succinate Crenolanib Besylate.
 26. Themethod of claim 18, wherein the FLT3 is at least one of FLT3-ITD orFLT3-TKD.
 27. The method of claim 18, wherein the patient is providedtreatment, and the method further comprises the steps of obtaining oneor more patient samples to determine the effect of the treatment, andcontinuing treatment until the FLT3 mutated proliferative disorder isreduced or eliminated.
 28. The method of claim 18, wherein thetherapeutically effective amount of crenolanib or a pharmaceuticallyacceptable salt thereof is at least one of: (1) administered at leastone of continuously, intermittently, systemically, or locally, (2)administered up to three times or more a day for as long as the subjectis in need of treatment for the FLT3 mutated proliferative disorder; (3)sequentially or concomitantly, with another pharmaceutical agent in anewly diagnosed FLT3 mutated proliferative disorder patient, to maintainremission, or a relapsed/refractory FLT3 mutated proliferative disorderpatient; (4) as a single agent or in combination with anotherpharmaceutical agent in a newly diagnosed FLT3 mutated proliferativedisorder patient, to maintain remission, or a relapsed/refractory FLT3mutated proliferative disorder patient; or (5) as a single agent or incombination with another pharmaceutical agent in a newly diagnosed FLT3mutated proliferative disorder pediatric patient, to maintain remission,or a relapsed/refractory FLT3 mutated proliferative disorder pediatricpatient.
 29. The method of claim 18, wherein the patient isrelapsed/refractory to a prior tyrosine kinase inhibitor or anotherchemotherapy.
 30. A method for treating a patient with a proliferativedisease comprising: obtaining a sample from the patient; determining ifthe patient that has become resistant to prior tyrosine kinaseinhibitors or chemotherapy and has a FLT3 mutated proliferativedisorder; and administering a therapeutically effective amount ofCrenolanib or a salt thereof to overcome the resistance to the priorprotein tyrosine kinase inhibitors.